A new approach to care for people experiencing a mental health crisis, emphasising continuity and community, can reduce hospital admissions and improve satisfaction with care, finds a study led by a University College London (UCL) researcher.
The study published in The Lancet Psychiatry is the first randomised controlled trial of Open Dialogue, which is both a treatment method and a way of organising mental health services.
Open Dialogue is a person-centred, network model that brings together patients, clinicians and members of a person's social network to plan and review care during and following a mental health crisis. Developed in Finland in the 1980s, it is already in use in some NHS trusts and is gaining considerable international interest, but evidence of its efficacy remains limited.
A core part of Open Dialogue is the use of regular network meetings, where the patient and members of their social network (which can be family, carers or friends) meet with two Open Dialogue practitioners, who then remain involved in the patient's continuing care after the crisis. The meetings focus on developing a shared understanding of the individual's mental health issues, seeking to increase personal agency and the development and maintenance of supportive relationships.
The ODDESSI trial of Open Dialogue included 494 participants who were either offered Open Dialogue or treatment as usual after presenting in crisis to a mental health service in England.
The researchers found no impact on the primary outcome of the trial – time to first relapse following initial recovery.
But there were promising findings on secondary outcomes of the trial. Those treated with Open Dialogue had more than three times higher odds of never being admitted to psychiatric inpatient hospital care, relative to those receiving treatment as usual, and lower odds of re-referral to crisis care over the study's two-year follow-up period. The researchers say these findings suggest that Open Dialogue may help to reduce NHS costs.
Open Dialogue was also associated with improvements in self-rated recovery, health-related quality of life, and satisfaction with services.
The study was funded by the National Institute for Health and Care Research and led by a UCL researcher in collaboration with North East London NHS Foundation Trust (NELFT – the trial sponsor), King's College London and international co-authors.
Lead author Professor Steve Pilling (UCL Psychology and Language Sciences) said: "Our results are encouraging, as we found that Open Dialogue can reduce hospital bed usage and improve people's satisfaction with their treatment and experience with mental health services. But we did not find any difference in time to relapse, an important measure of mental health treatment efficacy.
"People experiencing a mental health crisis can often end up getting seen by a number of different mental health teams, which can be frustrating and at times disjointed. Open Dialogue seeks to reduce movement between teams, thereby supporting the delivery of care that is collaborative and patient-centred.
"There is more work to be done to fully establish Open Dialogue's clinical effectiveness, refine its methods, and better understand the mechanisms underpinning its effectiveness."
The use of Open Dialogue in the study did not include family interventions, which are routinely used in Open Dialogue in Finland, or other forms of psychological interventions which are known to improve outcomes for a range of mental disorders. The authors also note there was less involvement of family or friends in network meetings than intended and relative to other applications of Open Dialogue. The benefits seen in this trial may, therefore, have been a result of improved mental health team functioning, but the researchers say that more work needs to be done to understand how Open Dialogue works best, and how to refine it for use in the UK setting.
The researchers are now working on expanding access to Open Dialogue across the UK while continuing to track efficacy of the approach with a particular focus on reducing the use of in-patient beds.
Mental health services are under enormous pressure, with many people stuck in a revolving door of crisis care and hospital admissions.
Too often care is disjointed, families are left out and not enough time is spent on forging a deep and lasting therapeutic relationship in our services. The ODDESSI trial shows that when care is built around relationships, mutuality, continuity and shared decision-making, people report better recovery, better quality of life and better experiences of care, while at the same time making far less use of inpatient or crisis services."
Professor Russell Razzaque, Co-author, Consultant Psychiatrist at NELFT and Professor of Relational Psychiatry at SOAS
Rachel Banister, who co-founded Mental Health – Time for Action after years of struggling to access the right support for her teenage daughters, turned to Open Dialogue, where she finally found an approach that worked. She said: "As a mum, all I have ever wanted is to be able to support my daughters, but for years I felt completely shut out of care and didn't know how to help. Decisions were made about our family without us, and my daughter saw countless professionals – having to repeat her story again and again, which was often retraumatising.
"Open Dialogue has completely changed that. For the first time, we were all in the room together, being listened to and heard. It allowed us to be honest, to be upset, and to start understanding each other in a way we never had before.
"We feel stronger as a family and no longer carry things on our own. In six months, one of my daughters has gone from being socially isolated, unable to work and relying on benefits, to completing her A-levels and securing a university place 120 miles from home - something we once thought would never be possible."
Source:
Journal reference:
Pilling, S., et al. (2026). Open Dialogue versus treatment as usual for adults presenting in crisis to mental health services in England (the ODDESSI Trial): a multisite cluster-randomised trial. The Lancet Psychiatry. DOI: 10.1016/S2215-0366(26)00229-4. https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(26)00229-4/fulltext
Facts Only
* A study was led by a University College London researcher.
* The study was published in The Lancet Psychiatry.
* The research was a randomised controlled trial of Open Dialogue.
* Open Dialogue is a person-centred, network model for mental health care.
* It involves patients, clinicians, and social network members planning and reviewing care during and after a mental health crisis.
* The method uses regular network meetings with two Open Dialogue practitioners.
* The ODDESSI trial included 494 participants in England.
* Participants were offered either Open Dialogue or treatment as usual after presenting in crisis to a mental health service in England.
* No impact was found on the primary outcome: time to first relapse following initial recovery.
* Those treated with Open Dialogue had more than three times higher odds of never being admitted to psychiatric inpatient hospital care relative to those receiving treatment as usual.
* Those treated with Open Dialogue had lower odds of re-referral to crisis care over a two-year follow-up period.
* Open Dialogue was also associated with improvements in self-rated recovery, health-related quality of life, and satisfaction with services.
Executive Summary
A study led by a University College London researcher published in The Lancet Psychiatry investigated Open Dialogue, a person-centred network model for mental health care. This research was the first randomised controlled trial of Open Dialogue. The method involves bringing together patients, clinicians, and social network members to plan and review care during and after a mental health crisis. It relies on regular network meetings focused on shared understanding, increasing personal agency, and developing supportive relationships.
The ODDESSI trial included 494 participants who either received Open Dialogue or usual treatment following a crisis in England. The study found no impact on the primary outcome of time to first relapse after initial recovery. However, those treated with Open Dialogue had more than three times higher odds of avoiding psychiatric inpatient hospital care and lower odds of re-referral to crisis care over two years. Furthermore, participants receiving Open Dialogue reported improvements in self-rated recovery, health-related quality of life, and satisfaction with services.
The researchers suggest these findings indicate that Open Dialogue may reduce NHS costs. The approach aims to foster collaborative and patient-centred care by reducing movement between different mental health teams. While the study noted limitations regarding the inclusion of family interventions compared to Finnish practice, the observed benefits are suggested to stem from improved team functioning.
Full Take
The findings suggest that restructuring mental health support around relational dynamics—emphasizing continuity, mutuality, and shared decision-making within a social network—can yield tangible administrative and experiential benefits, even when core clinical efficacy markers remain unchanged. The primary mechanism highlighted appears to be systemic friction reduction: by embedding care within the patient’s existing support structure rather than relying on disjointed handoffs between specialist teams, the system manages crises more effectively and reduces reliance on high-cost inpatient settings.
The fact that the trial did not show a difference in time to relapse is crucial; it separates process improvements (how care is delivered) from clinical outcomes (the biological trajectory of recovery). This forces a re-evaluation of what constitutes 'efficacy' in crisis management—is it solely symptom reduction, or does reducing systemic burden and enhancing relational quality also constitute success? The noted limitations regarding the degree of family involvement suggest that while the network structure promotes beneficial interactions between professional teams, integrating familial support requires further refinement to ensure benefits are universally accessible.
The narrative presented by the participants underscores a tension between institutional pressures (cost reduction, system efficiency) and human needs (agency, connection). The observable benefit in satisfaction and reduced inpatient use points toward a necessary shift in valuing relational processes as integral components of clinical intervention, rather than ancillary activities. What is not fully quantified is the long-term impact of maintaining this network approach outside the structured trial environment, and how to ensure that innovations rooted in person-centred care are integrated without sacrificing the depth of therapeutic relationship development or procedural rigor.
Bridge Questions: If Open Dialogue demonstrably reduces system costs by altering inpatient utilization, what specific metrics should be prioritized alongside satisfaction and quality of life to fully assess its long-term societal benefit? How can practitioners practically incorporate the network meetings more effectively into existing multi-disciplinary structures without introducing administrative burden that negates potential benefits? What conditions must be met for Open Dialogue principles to translate from promising trial outcomes into standard, widely accepted clinical protocols across diverse healthcare settings?
Sentinel — Human
The text reads as a synthesis of scientific research and personal testimony, exhibiting the characteristic balance and layered complexity typical of high-quality journalistic reporting on a medical topic.